Occupational Health and Safety in the Philippines ORIGINAL

CASE
CASE REPORT
REPORT
ARTICLE

A Study on Heart Failure

the State and Short Stature
of Occupational inand
Safety a 43Health
year-old
inmale
the Philippines
Katerina
Katerina T.
T. Leyritana
Leyritana11,, Ma.
Ma. Czarlota
Czarlota M.
M. Acelajado-Valdenor
Acelajado-Valdenor11,, Amado
Amado O.
O. Tandoc
Tandoc III
III22 and
and Agnes
Agnes D.
D. Mejia
Mejia11
Jinky Leilanie D. Lu
Department
Department of
11
of Medicine,
Medicine, College
College of
of Medicine
Medicine and
and Philippine
Philippine General
General Hospital,
Hospital, University
University of
of the
the Philippines
Philippines Manila
Manila
22
Department
Department of
of Pathology,
Pathology, College
College of
of Medicine,
Medicine, University
University of
of the
the Philippines
Philippines Manila
Manila
National Institutes of Health
University of the Philippines Manila

GLOSSARY OF TERMS
Occupational Safety and Health (OSH) – “Defined as the a)
Presentation
Presentation of of the
the case
case require
require regular
promotion regular laxative
laxative use.
and maintenance use.ofThere
There was
was also
the highest also aa report
degree report of
of two
two
of physical,
This
This is is aa case
case ofof aa 43-year-old
43-year-old male male presenting
presenting withwith short
short more
more syncopal
syncopal episodes.
episodes. He
He was
was brought
brought
mental and social well-being of workers in all occupations; b) to
to another
another doctor
doctor
stature
stature and and heart
heart failure.
failure. TheThe patient
patient was was admitted
admitted at at the
the in
in aa private
private
prevention hospital
hospital
among where
whereof
its workers the
the
any assessment
assessment
departures was was still
from still
healthaa “heart
“heart
caused
medicine
medicine ward ward of of the
the Philippine
Philippine General
General Hospital
Hospital (PGH)
(PGH) problem”.
problem”. The
The patient
patient was
was again
again
by their working conditions; c) protection among workers in theirprescribed
prescribed unrecalled
unrecalled
for
for dyspnea.
dyspnea. This This paper
paper will will investigate
investigate several
several issues:
issues: medications
medications and and againagain was was lost lost to to follow-up.
follow-up. This This time,
time,
employment from risks usually from factors adverse to health and
differentiating
differentiating congenital
congenital from from acquired
acquired hypothyroidism,
hypothyroidism, however,
however, symptomssymptoms were were persistent.
persistent. He He later
later consulted
consulted at at
d) placing and maintenance of the worker in an occupational
the
the relationship
relationship between between hypothyroidism
hypothyroidism and and the the another
another local local hospital,
hospital, where where he he was
was admitted
admitted and and managed
managed
environment adapted to his/her physiological ability.”1
cardiomyopathies,
cardiomyopathies, and and thethe therapeutic
therapeutic optionsoptions in in patients
patients as
as aa case
case of of anemia
anemia and and bronchial
bronchial asthma.asthma. He He waswas discharged
discharged
with
with cardiomyopathy
cardiomyopathy secondary secondary to to hypothyroidism.
hypothyroidism. slightly
slightly improved
improved after after four
four days,
days, onlyonly to to have
have recurrent
recurrent heartheart
Occupational Hazards - “Refers to various environmental
The
The patient
patient hadhad beenbeen born
born fullfull term
term to to aa then
then 31-year-
31-year- failure
failure symptoms,
symptoms, prompting prompting admissionadmission at at PGH.
PGH.
factors or stresses that can cause sickness, impaired health, or
old
old Gravida
Gravida 44 Para Para 33 (G4P3),
(G4P3), the the 44thth of
of 99 siblings,
siblings, with
with an an Upon
Upon admission
admission the the patient
patient was was in in mild
mild respiratory
respiratory
significant discomfort in workers and can be classified as chemical,
apparently
apparently unremarkable
unremarkable delivery delivery at at home
home facilitated
facilitated by by distress,
distress, with with stable
stable vital
vital signs
signs and and no
no note
note of
of fever.
fever. Pertinent
Pertinent
physical, biological or ergonomic.”1
aa traditional
traditional birthbirth attendant.
attendant. He He was
was notednoted to to be
be normal
normal physical
physical exam exam findings
findings included
included short short stature,
stature, thick
thick lips,
lips, non-
non-
at
at birth.
birth. TheThe patient
patient was was allegedly
allegedly at at par
par with
with age
age both
both pitting
pitting periorbital
periorbital edema, edema, dry dry skin,
skin, aa displaced
displaced apicalapical impulse,
impulse,
Occupational Health- “The discipline which aims to promote
physically
physically and and mentally
mentally untiluntil eight
eight years
years oldold when
when he he was
was crackles
crackles on on both
both lung
lung fields,
fields, and and bilateral
bilateral non-pitting
non-pitting bipedalbipedal
and maintain the highest degree of physical, mental and social
said
said to
to have
have stopped
stopped growing
growing in in height.
height. He He was
was brought
brought to to edema.
edema. There There was was also also aa 33 cm cm xx 33 cm cm reducible
reducible umbilical
umbilical
well-being of workers in all occupations by preventing them from
aa private
private doctor,
doctor, whose
whose diagnosis
diagnosis was was undisclosed,
undisclosed, and and he he hernia.
hernia. However,
However, there there waswas no no pallor,
pallor, no no neck
neck vein
vein distention,
distention,
getting sick, controlling health and safety hazards at work and by
was
was given
given medications
medications to to increase
increase height,
height, whichwhich the
the patient
patient no
no apparent
apparent congenital
congenital malformations,
malformations, no no1 cardiac
cardiac murmurs
murmurs
placing them in tasks adapted to their ability.”
took
took for
for only
only one
one month
month with with no no improvement.
improvement. Through Through the the and
and nono clubbing.
clubbing. There There was was also
also no no note
note of of an
an anterior
anterior neckneck
years,
years, thethe patient
patient waswas apparently
apparently well, well, although
although still
still of
of short
short mass.
mass.
Occupational Disease- “Abnormal condition or disorder caused
stature,
stature, withwith thick
thick lips,
lips, coarse
coarse facial
facial features
features andand dry
dry skin.
skin. Laboratory
Laboratoryworkup workupshowed showedcardiomegaly
cardiomegalywith withpulmonary
pulmonary
by exposure over a period of time to work-related risk factors such
He
He was
was notably
notably slowslow in in ambulation.
ambulation. He He waswas said
said toto have
have congestion,
congestion,thoracic thoracicdextroscoliosis,
dextroscoliosis,and andatheromatous
atheromatousaorta aortaby by
as inhalation of dusts, exposure to certain chemicals, carrying out
bronchial
bronchial asthma
asthma at at age
age 1515 years,
years, and
and since
since then
then he
he had
had been
been chest
chest radiograph,
radiograph, and and left
left ventricular
ventricular hypertrophy
hypertrophy by by 12-lead
12-lead
repetitive movements and contact with some pathogens.” 2
taking
taking salbutamol
salbutamol tablets
tablets occasionally
occasionally for for bouts
bouts ofof dyspnea
dyspnea electrocardiogram
electrocardiogram (12-L (12-L ECG)ECG) (Figures
(Figures 11 and and 2),2), normocytic
normocytic
occurring
occurring one one toto two
two times
times annually.
annually. normochromic
normochromic anemia anemia (Hgb (Hgb 90 90 mg/dL),
mg/dL), dyslipidemia,
dyslipidemia, and and
pre-renal
pre-renal azotemia
azotemia (serum (serum Introduction
creatinine
creatinine 123 123 mmoL).
mmoL). Electrolytes
Electrolytes
The
The patient’s
patient’s symptoms
symptoms started started in in 2001
2001 when
when he he was
was
reported
reported to to have
have sudden
sudden loss loss of of consciousness.
consciousness. During During this this on Occupational
on admission
admission showed
showed Safety slight
slight and Health (OSH)
hyponatremia,
hyponatremia, in the
hypokalemia,
hypokalemia,
time,
time, the
the patient
patient did
did notnot have
have any any symptoms
symptoms of of heart
heart failure;
failure; Philippines
and
and hypochloremia was
hypochloremia (serum implemented
(serum Na Na 136,by virtue
136, K K 3.35, of
3.35, Cl Executive
Cl 86). BloodOrder
86). Blood gases
gases
no
no prior
prior seizures,
seizures, cyanotic
cyanotic episodes,
episodes, chestchest pain,
pain, headache,
headache, or or 307. It
revealed aims
revealed partially to serve
partially compensated and protect
compensated metabolic workers alkalosis untoward
metabolic alkalosis from with
with mild
mild
blurring
blurring of of vision.
vision. HeHe regained
regained consciousness
consciousness shortlyshortly after
after and
and risks and hazards
hypoxemia.
hypoxemia. The
The patient that was
patient can noted
was adversely
noted to
to bebe affect their health,
hypothyroid
hypothyroid based
based
was
was brought
brought to to aa private
private physician,
physician, whose
whose assessment
assessment was was aa welfare,
on
on elevated
elevated safety,serum
serum well-being.3 With hormone
andthyroid-stimulating
thyroid-stimulating EO 307, the
hormone national
(TSH)
(TSH) and
and
“heart
“heart problem”.
problem”. He He waswas prescribed
prescribed unrecalled
unrecalled medications
medications system
markedly for
markedly decreased occupational
decreased serum safety
serum free and health
free thyroxine referred
thyroxine (FT4). (FT4). The Theas
to the
exact
exact
taken
taken forfor aa few
few months
months and and eventually
eventually discontinued
discontinued when when Philippine
values
values are are shownNational
shown in OSH
in Tables system
Tables 11 and and 2. 2. was created to provide
the
the syncopal
syncopal episode
episode did did not
not recur.
recur. national
Uponpolicies
Upon admission
admission andtotoprograms
the
the wards,
wards, fortheoccupational
the patient
patient waswassafety
managed
managed and
In
In the the next
next fourfour years,
years, the the patient
patient would would develop
develop health
as
as having in the
having congestivePhilippines.
congestive heart Its key
heart failure players
failure from are the Department
from cardiomyopathy
cardiomyopathy
_______________ of Labor and
intermittent,
intermittent, progressive
progressive exertional
exertional dyspneadyspnea and and bipedal
bipedal secondary
secondary to Employment
to acquired (DOLE), employers
acquired hypothyroidism.
hypothyroidism. Oral
Oral loop and diuretics,
loop workers’
diuretics,
edema.
edema. LaterLater onon this
this would
would be be accompanied
accompanied by by generalized
generalized organizations,
angiotensin-converting
angiotensin-converting and other government
enzyme
enzyme (ACE) agencies.
(ACE)
3
inhibitors,
inhibitors, beta- beta-
body
body weakness,
weakness, anorexia,
anorexia, and and constipation,
constipation, severesevere enough
enough to to The declared
blockers,
blockers, statins,
statins, and policies
and under this
levothyroxine
levothyroxine executive
were
were started.order
started. are 1)
Electrolyte
Electrolyte
“to upgrade
correction
correction wasthe
was capability
instituted.
instituted. The
The of sections
Government
sections of to prevent,
of Endocrinology
Endocrinology
Corresponding author: Jinky Leilanie D. Lu, MOH, PhD eliminate
and
and Cardiovascularor reduceDiseases
Cardiovascular work-related
Diseases were injuries, illnesses
were co-managing
co-managing the
the patientand
patient
Corresponding
Corresponding
National Institutesauthor:
author: Ma.
Ma. Czarlota
of Health Czarlota Acelajado-Valdenor,
Acelajado-Valdenor, M.D.
M.D. deaths inwithorder
Department
Department
University of
of Medicine
of the Medicine Manila
Philippines
together
together with thetoGeneral
the containMedicine
General economicservice.
Medicine losses in terms of man-
service.
Philippine
Philippine
625 Pedro GilGeneral
General Hospital
Hospital
St., Ermita, Manila 1000 Philippines hours,
He
He soon destruction
soon developed
developed of respiratory
property failure,
respiratory and expenditure
failure, upon
upon whichwhich the for
the
Taft
Taft Avenue,
Avenue,
Telephone: +632Manila,
Manila,
52642661000
1000 Philippines
Philippines employee’s
considerations
considerations compensation,
were
were acute as well ascongestion,
acute pulmonary
pulmonary social costnosocomial
congestion, related to
nosocomial
Telephone:
Telephone:
Email: +632
+632 554-8488
554-8488
jinky_lu@yahoo.com the sufferingto
pneumonia,
pneumonia, toofrule
victims
rule out
out ananofacute
industrial
acute coronary
coronary accidents
event.or
event. Heoutbreaks
He was
was later
later
Email:
Email: czarlota@yahoo.com
czarlota@yahoo.com

12
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52 ACTA
ACTA MEDICA
MEDICA
MEDICA PHILIPPINA
PHILIPPINA
PHILIPPINA VOL.
VOL.45
VOL. 43
43NO.
N0.
N0. 434 2009
2009
2011
 Heart Failure
Occupational and Short
Health andStature
Safetyinina the
43 year-old male
Philippines

Table 1. Initial Laboratory

of occupational diseases andResults
their families; 2) to implement Methods
effectively occupational health and safety programs that will A comprehensive analysis of records and statistics on
CBC Blood chem. Urinalysis ABG
promote the health, efficiency and general well-being of the occupational safety and health and related variables from
Reference
Filipino workers Reference
through the Result
improvement of the quality of theResult
Bureau of Labor Color straw
and Employment pH
Statistics (BLES)7.408
of the
Value Value
working
WBC life that
5-10
will enhance 4.5
significantly
RBS the productivity
3.9-6.1 Department
6.3 of Labor
Transp and Employment
Clear (DOLE),
pCO2 the Labor
49.1
ofRBC
industries 4-6 and business all being critical HGBA1C factors in4.27-6.07
the Force
6.4 Survey Sp ofGravity
National Statistics
1.010 Office,
pO2 the Overseas70
HGB
attainment of national development
120-150 90 BUN
goals; and 3) 2.6-6.4
to 5.0
Employment pH
Statistics (OES) 8.0 HCO3
of the Philippine 31.3
Overseas
HCT
maintain an 0.38-0.48
expert intelligence0.27 and CREA training center53-115 for 123
Employment Sugar
Administration NEG
(POEA), andO2 sat 93.6
the International
MCV 80-100 FL ALB 34-50 32 Protein NEG FiO2 21%
industrial disease and occupational safety that will provide Labor Organization (ILO), the University of the Philippines,
MCH 27-31 PG TAG 0.34-1.7 0.82 RBC 0-1 Temp 36.9
the
MCHC operational320-360framework
G/L and mechanisms
HDL for 0.91-1.56
the and0.67non-government
WBC organizations 0-2 was conducted. Data
achievement
RDW of the objectives
11.5-15.5% set forth in E.O.
LDL 307, the Labor
1.1-3.8 was4.21also gathered Castfrom a review of literature, PBSincluding
PLT of the 200-400
Code Philippines as Inc amended,TOTAL and CHOL 4.2-5.2
other related 5.25 research
related Epith cell
studies, and Rare
documentary research at the
Slight poikilocytosis,
RETIC
legislations.” 0.005-0.015
4 AST 15-37 95
Occupational Bacteriaand Health
Safety Occ’lCenteracanthocytes,
(OSHC). ovalocytes,
Data was
SEG 50-70% 48 ALT 30-65 91 Mucus th Rare
In the Philippines, the legal provisions addressing analyzed through critical appraisal slight of toxic
OSH granulation,
in the
LYMPH 20-44% 50 Alk po4 184 Crystals Rare slight anisocytosis
occupational
MONO health are the Philippine
2-9% 2 Constitution
NA of 140-148
1987, Philippines
136.9 in terms
Am urates of occupational diseases, injuries and
the
EO Philippine 0-4% Labor Code of
0 Book IV,K and Occupational
3.6-5.2 accidents,
3.35 and existing occupational safety and health
BASO and 0-2%
Health Safety Standards 0 of 1978. CL3 The Bureau 100-108
of 86
policies.
BLAST 0% 0 CA++ 2.12-2.52 2.37
Working Conditions (BWC) under the Department of Labor
P 2.27
and Employment (DOLE) collects and MG++ compiles the Work 0.74-1 0.83 Results
Accident Injuries Report (WAIR) and the Annual Medical
Report (AMR) from establishments yearly as well as 1.0 Cases of Occupational Hazards and Diseases
monitors industries with regards to their compliance to OSH According to the World Health Organization (WHO)
standards. The Bureau of Tests
Labor and Employment Statistics fat
andpad.
the Cardiac enzymes
International Laborwere not consistent
Organization (ILO),with
1.1anmillion
acute
Table 2. Thyroid Function
(BLES) of DOLE conducts the annual BLES Integrated coronary event (Table 3), however, intravenous
people die annually due to unsafe and unhealthy work (IV) heparin
Reference Value Result (overlapping
Survey
Free T4 (BITS). The Occupational
(0.8-2.0) Safety and0.02 Health
ng/dL Center environments.with Anoral warfarin)160
estimated wasmillion
still givennewto cover
cases for
of
(OSHC) keeps a database of Approved Cases of Uiu/ml
Occupational the presence of a possible LV thrombus as
occupationally related diseases occur in the world yearly. demonstrated
TSH (0.4-6.0) 24.75
Injuries and Diseases under the Employees' Compensation by
Amongrheologic stasis
these are on cardiac
respiratory and ultrasound.
cardiovascular Medications
diseases,
Program. The other agencies that contribute to the were shifted to IV diuretics and inotropes; oral
cancers, hearing loss, musculoskeletal and reproductive digoxin was
strengthening occupational safety and health in the started. IV antibiotics were given for possible
disorders, mental and neurological illnesses, among others.5 pulmonary
infection.
The number The patient later on
of fatalities showed
caused byimprovement,
hazardous and andtoxic
was
Philippines are the Department of Health, other government
eventually weaned off from ventilatory support, extubated,
agencies, the private sector, professional organizations such chemicals alone was estimated at 651,000. Occupational 2,6

as the Philippine College of Occupational Medicine, the diseases, injuries and fatalities have socioeconomic cost. A
Occupational Health Nurses’ Association of the Philippines, Table
study 3.onCardiac Enzymes
the socioeconomic cost of road accidents in the
and non-governmental organizations (NGOs) such as the Philippines, specifically in Metro Manila, revealed
Reference Range (mmoL) Resultthat about
Safety Organization of the Philippines, Inc., Trade Union P3.5M is lost
Qualitative per fatal road accident. Social cost is estimated
POSITIVE
Congress of the Philippines, and the NGO Health toTroponin
be about I P506,450 per fatal accident.7
Alternatives for Total Human Development Institute. The CK-MB 0-6.0 1.14
University of the Philippines, on the other hand, offers 2.0CK-TOTAL 21-232
Occupational Hazards and Diseases among543
undergraduate and graduate level training in occupational Marginalized/Unprotected Workers
health.1 Short courses in hygiene and safe work practices are
also offered directly to employees. The OSHC also offers The Informal Sector
similar training for workers and employers. In addition, the The informal sector is defined by the Department of
Figure
UP 1. Electrocardiogram
School of Labor and Industrialupon admission
Relation offers training Labor and Employment as the own-account workers and
programs on industrial relations and occupational safety.3 unpaid family workers.8,9 Workers in the sector are defined
This study provides significant motivation for as “self-employed without any employee; employer in own
transferred to the intensive care unit (ICU) for ventilatory
promoting safety in the workplace. Generally, the study farm or business; a domestic helper, family driver and other
support and closer monitoring. On bedside cardiac ultrasound,
aimed to show the current state of occupational safety and household helper who assist in the family-operated
there was a finding of eccentric left ventricular hypertrophy,
health in the country. Specifically, the objectives were 1) to business, regardless of time spent in this activity; a person
global hypokinesia with depressed overall systolic function
show the current condition of workers, both local and who worked with pay on own family-operated farm or
with concomitant spontaneous echo contrast on left ventricular
migrant workers, in terms of their workplace condition and business.”8
(LV) cavity suggestive of rheologic stasis, the ejection fraction
hazard exposures; and 2) to present occupational diseases
was 25%, with moderate mitral regurgitation, moderate
and
aorticillnesses in the Philippines.
regurgitation with aortic sclerosis, severe tricuspid Waste/garbage Pickers
regurgitation with mild pulmonary hypertension, pulmonary Waste/garbage pickers are exposed to an unsanitary
regurgitation, and minimal pericardial effusion or pericardial work environment.
Figure They on
2. Chest radiograph suffer cuts from broken glass,
admission

VOL. 45
VOL. 43 NO.
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2011 ACTA MEDICA
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PHILIPPINA 53
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Occupational Health and Safety in the Philippines CASE REPORT

exposure to methane Heart gas fromFailure leachates and and Short Stature
decomposing in a 43tedious
environment, year-old work, male fast-paced production,
garbage, tetanus from contaminated objects, and hazards aggravated by the burden of household work.17 In another
Katerina
from medical T. Leyritana
wastes. 10 1
, Ma. Czarlota M. Acelajado-Valdenor study,1, women
Amado O. Tandoc
workers in IIIthe
2
and Agnes D.and
electronics Mejia garment
1

industries were subjected to time pressure to produce

Child Labor 1
Department of Medicine, College of Medicine and Philippinequotas, General Hospital,
nightshiftUniversity
work, of the
andPhilippines
exposure Manilato various other
Child labor has been2Department a serious of Pathology,
problemCollege in oftheMedicine, University of the
occupational Philippines
hazards. 18 As Manila
a result of exposure to these
Philippines. Sixteen percent of the 830,000 children in the occupational hazards, women informal workers mostly
Philippines are engaged in child labor employment experience health-related problems such as changes in blood
according to the National Statistic Office and the United pressure and heart rate, ulcers, migraines, and menstrual
Nations Children's Emergency Fund survey.11 Of these, irregularities.1,9
670,000 were children attending both school and work as On the other hand, Estrella-Gust 3 noted in her study
child laborers.11.12 Child laborersofare
Presentation thecommonly
case employed in require
that women regularworkers
laxative in use. There was
informal also a report
economy such as of two
pili
small This scale
is aindustries, in street vending,
case of a 43-year-old prostitution,
male presenting withmuro-
short more syncopal
processing, episodes.
bamboo craft He was broughtincluding
manufacturing to anotherbag doctor
and
ami fishing
stature and heartand failure.
in agriculture.
The patient In wasMindanao,
admitted children
at the in a private
picture frame hospital
making, where the assessment
sea grass was still aslippers
or gas processing, “heart
working in
medicine ward plantations are involved
of the Philippine General in Hospital
trimming(PGH) and problem”.
and bags The patient from
production was againsea grass,prescribed
and crabunrecalled
paste
fertilizing
for dyspnea. plants,This andpaper
clearing willirrigation
investigate ditches. It was
several also
issues: medications and again was
processing experienced joint lost
pains,to headaches,
follow-up. and This finger
time,
documented that
differentiating children involved
congenital from acquired in fishing in Mindanao
hypothyroidism, however,
cuts due tosymptoms
sharp tools. were
15 persistent. He later consulted at
were engaged
the relationship in thebetween
docks of Mindanao hypothyroidism and Visayan and ports the another local hospital, where he was admitted and managed
or as divers in coraland reefthefishing. 7 Even in home-based jobs,
cardiomyopathies, therapeutic options in patients as
3.0aSpecific
case of anemia
Research andandbronchial
Studiesasthma. He was discharged
on Occupational Risk
child cardiomyopathy
with labor is often involved secondary(work in the mining and
to hypothyroidism. slightly
Factors perimproved
Industry after four days, only to have recurrent heart
quarrying
The patient industry).
had been 3 In the study of Lu in Metro Manila,
born full term to a then 31-year- failure symptoms,
According prompting
to the Employee admission
Compensation at PGH.(EC) records,
childGravida
old laborers4 Para were 3subjected
(G4P3), the to 4heavy
th
of 9 lifting
siblings, in with
certainan Upon admission theworkers
laborers/maintenance patient was (18%) in mild respiratory
followed by
works.
apparently 13
unremarkable delivery at home facilitated by distress, with stable vital
professional/technical signs and
workers no note
(16.5%) andof fever.
teachersPertinent
(14%)
a traditional
Table 1 lists birth attendant.
child He was noted
labor employment by age to group
be normal and physical
are the exam groups findings
that included
experience shortprevalent
stature, thick lips, non-
occupational
at birth.
sex in theThe yearspatient
2008 and was2009. allegedly
There at wereparmorewithmalesage both
than pitting
hazards, periorbital
diseases,edema, dry skin, aCardiovascular
and accidents. displaced apicaldisease impulse, is
physically
females engaged and mentally
in childuntil labor.eight There years
wasold when heinwas
a decrease the crackles
the on both lung
leading fields, and bilateral
occupational disease,non-pitting
followed bipedal by
said
number to have stopped children
of employed growing from in height.
2,153He was brought
in 2008 to 2,027 in to edema. There was
cerebrovascular also a 3and
accidents cmpulmonary
x 3 cm reducible umbilical
tuberculosis. 19 In

a2009.
private
12
doctor, whose diagnosis was undisclosed, and he hernia. However, there was no pallor,
the health services sector, workers commonly experience no neck vein distention,
was given medications to increase height, which the patient no apparent
mental stresscongenital
in meeting malformations,
deadlines. Those no cardiac
in the murmurs
postal
Table
took for 1. only
Child oneLabor
month Employment
with no improvement.by Age Group and Sex,
Through the and no clubbing. There was also no
services report heat, noise and chemicals as the most note of an anterior neck
2008
years,and the2009 (in thousands)
patient was apparently well, although still of short mass.
common occupational hazards. For maritime workers,
stature,
Age
with thick lips, 2008
coarse facial features2009 and dry skin. Laboratory
extreme workup showed
temperatures, chemicals cardiomegaly
and frequent with pulmonary
travel are the
HeGroupwas notably Male slow
Femalein ambulation.
Total Male He was said
Female to have
Total congestion, thoracic dextroscoliosis,
common occupational concerns. The prevalence and atheromatous aorta by of
bronchial
5-9 asthma
49 at36age 15 years, 85 and 36 since then 28 he had 64 been chest radiograph,
occupational and left
diseases andventricular
injuries inhypertrophy
the private by 12-lead
sector can
taking
10-14 salbutamol 401 tablets
241 occasionally
642 377 for bouts 209 of dyspnea586 electrocardiogram
be ascertained by (12-L ECG) (Figures
the number 1 and 2),work-related
of approved normocytic
15-17 915 510 1,425 892 485 1,377
occurring one to two times annually. normochromic anemia (Hgb 90 mg/dL),
illnesses and injuries by the Social Security System (SSS). dyslipidemia, and
Total 1,365 788 2,153 1,305 722 2,027
The patient’s symptoms started in 2001
Source: National Statistics Office, Labor Force Survey, 2010 (NSO, 2010) 12 when he was pre-renal azotemia (serum creatinine
Records show a total of 1,729 (91%) approved cases of 123 mmoL). Electrolytes
reported to have sudden loss of consciousness. During this on admissionaccidents/injuries
occupational showed slight hyponatremia,
and 1,070 or 9%hypokalemia,
work-related
time, theIssues
Gender patient did not have any symptoms of heart failure; and hypochloremia (serum
illnesses by the Social Security System. Na 136, K 3.35,
20 Cl 86). Blood gases
no priorWomen’s seizures, cyanotic episodes,
participation in the labor chest pain,
force headache,
is another or
issue revealed partially compensated metabolic alkalosis with mild
blurring
of unprotectedof vision. He regained
workers. Edralin consciousness
14 and Estrella-Gustshortly15after and
studied hypoxemia.
AgriculturalThe and patient
Fishing was noted to be hypothyroid based
Sectors
wasfeminization
the brought to a of private physician,in
the workforce whose assessment
industries, was a
specifically on elevated serum thyroid-stimulating
The study conducted in Buguias, Benguet hormoneand (TSH) and
Bauco,
“heart
the problem”.
garment He wasinprescribed
industry, the shoe,unrecalled microchip,medications
computer markedly decreased serum free thyroxine
Mountain Province, revealed that farmers frequently (FT4). The exact
taken for a fewand
manufacturing months and eventually
electronics industries, discontinued
operating inside when values are shown
experienced muscle in Tables
cramps, 1 and 2.
weakness and respiratory tract
the syncopal
export episode
processing did not
zones in recur.
the Philippines. The reported irritation. This was reiterated in the
Upon admission
21 to the wards, the patient
study of was Lumanaged
in 2009
In the next four years, the
occupational risks to women in these industries were low patient would develop as having congestive heart failure
wherein she reported that vegetable farmers in Benguet from cardiomyopathy
intermittent,
salaries, progressive
exposure to toxic exertional
substances,dyspnea respiratory and diseases,
bipedal secondary
province are to acquired
exposed hypothyroidism.
to organophosphates, Oral loop diuretics,
carbamates,
edema. Later on this
and musculoskeletal problems. would be 3 accompanied by generalized angiotensin-converting enzyme (ACE)
organochlorines, and pyrethroids. Further, the pesticide
22 inhibitors, beta-
bodyBoth weakness, anorexia, and constipation,
women and men informal workers experience severe enough to blockers, statins, and levothyroxine were
residues found in the vegetables and soil revealed use of started. Electrolyte
occupational hazards, but women are more vulnerable to correction
banned andwas instituted.
restricted The sections
pesticides. 23 In theofstudy Endocrinology
of Cheng
them. Women migrant workers are more typically subjected and
(1994)Cardiovascular
in Benguet Diseases
province, were
2,000 co-managing
vegetable the patient
farmers were
Corresponding author: Ma. Czarlota Acelajado-Valdenor, M.D.
to sexual and
Department physical abuses and maltreatment by their
of Medicine together
diagnosed with the General
to have allergicMedicine
reactionsservice.
both in the skin and the
Philippine General
employers. 16 Women Hospital informal workers carry a double eyes,Heandsoonsuffered
developed fromrespiratory
abdominalfailure, pain, upon whichchest
dizziness, the
Taft Avenue, Manila, 1000 Philippines
burden from their occupation and household work. They are considerations were acute pulmonary
pain, headache and nose bleeding due to exposure to congestion, nosocomial
Telephone: +632 554-8488 pneumonia,
exposed to
Email: czarlota@yahoo.comstress brought about by the physical pesticides.24 to rule out an acute coronary event. He was later

12 ACTA MEDICA
54 ACTA MEDICA PHILIPPINA
PHILIPPINA VOL.45
VOL. 43NO.
N0. 43 2009
2011
 Heart Failure
Occupational and Short
Health andStature
Safetyinina the
43 year-old male
Philippines

TableIn1.another
Initial Laboratory Resultsin Southern Cebu, Central
study conducted disturbances, and gastrointestinal diseases, mental
Visayas, and Palawan, results revealed that fishermen who disorders, and cardiovascular diseases.3
CBC Blood chem. Urinalysis ABG
were involved in deep sea fishing, also known as the “pa- In 2007, a stress-induced death of a call center agent was
Reference Result Reference Result Color straw pH 7.408
aling” method, manifested diarrhea, dermatitis, and cough reported in the media. In 2008, the Ecumenical Institute for
Value Value
due
WBCto poor5-10 sanitation and4.5poor working
RBS environment
3.9-6.1 Labor
6.3 Education and
Transp Research,
Clear Inc. (EILER)
pCO2 conducted
49.1 a
aboard
RBC the fishing
4-6 boats. There were HGBA1C
also chronic health
4.27-6.07 study
6.4 on call Sp centers
Gravityand revealed
1.010 thatpO2
there are various
70
HGB
complaints from
120-150the fishermen
90 such BUN 2.6-6.4
as musculoskeletal 5.0
occupational pH risks in8.0this type
health HCO3 of job such 31.3 as
HCT
discomfort/pain,0.38-0.48 CREA
0.27 easy fatigability,
sleep disorders, 53-115
dizziness 123
graveyard shifts,Sugar
long working NEG hours, O2 sat temperatures,
low 93.6
MCV 80-100 FL ALB 34-50 32 Protein NEG FiO2 21%
and poor appetite. Majority of the fishermen in the study psychological insults from clients, and high work stress.
MCH 27-31 PG TAG 0.34-1.7 0.82 RBC 0-1 Temp 36.9
had abnormal320-360
MCHC laboratory
G/L findings and hearing
HDL impairment.
25
0.91-1.56 Consequently,
0.67 many call 0-2center workers reported
WBC
RDW 11.5-15.5% LDL 1.1-3.8 experiencing
4.21 sleeping
Cast problems, eye strain, overall PBS fatigue,
PLT
Industrial 200-400
Sector Inc TOTAL CHOL 4.2-5.2 5.25
headaches, chestEpith
andcellback pains,
Rarevoice problems and mental
Slight poikilocytosis,
RETIC 0.005-0.015
In the study conducted in nine cement AST plants in15-37
the 95 34
stress. Bacteria Occ’l acanthocytes, ovalocytes,
SEG 50-70% 48 ALT 30-65 91 Mucus th Rare
Philippines, workers were noted to be exposed to hazards In small-scale laundry shops slight and toxic
drygranulation,
cleaning
LYMPH 20-44% 50 Alk po4 184 Crystals Rare slight anisocytosis
such
MONO as heat,2-9%noise and dust 2 (Occupational
NA Health140-148
and establishments,
136.9 occupational
Am urates hazards noted in a study were
Safety
EO Fact Funding0-4% Survey). 0
26 K 3.6-5.2 chemical
3.35 exposures in the laundry process, dust from clothes
BASO 0-2%
In the electronics CL
sector, 0about 57 Filipino women 100-108
were and86powder detergents, noise, heat, poor ventilation of the
BLAST CA++
afflicted by 0%Stevens–Johnson 0 Syndrome (SJS) in 2.12-2.52
two 2.37
workplace, and ergonomic hazards such as prolonged
P 2.27
electronic factories in Taiwan. Another MG++
27 study of 399 female
0.74-1 standing
0.83 and repetitive work. The most common complaints
workers in a semiconductor manufacturing industry reported by the workers were musculoskeletal diseases.35
reported abnormal health effects of hazard exposure such as Among migrant workers, accidents and musculoskeletal
abortion, ectopic pregnancy, or stillbirth.28 The women diseases top the list of causes of morbidity, followed by
workers in semiconductor and microelectronic industries in fat pad. Cardiacdiseases
cardiovascular enzymes andwere not consistent
inflammatory with an
diseases. Casesacute
of
Table 2. Thyroid Function Tests
the Philippines showed symptoms related to central nervous coronary event (Table 3), however, intravenous
infection were mostly tuberculosis. Cases of accidents (IV) heparin
Reference Value Result (overlapping with oral
and irritative
Free T4 symptoms(0.8-2.0)
referring to the respiratory tract and
0.02 ng/dL included fractures and warfarin) was stilland
crushing injuries given to cover
burns. Among for
skin.28 These women(0.4-6.0)
theTSH workers were also 24.75
exposed to work the presence of a possible LV thrombus
the types of occupations, the domestic helpers had the as demonstrated
Uiu/ml
stress, overtime work, stress,29 and experienced by rheologic
highest number stasis on cardiac particularly
of complaints ultrasound. those Medications
in the
musculoskeletal disorders and carpal tunnel syndrome.30 were shifted to IV
Middle Eastern countries.diuretics and
36 inotropes; oral
About 40% of workersdigoxin was
In another study conducted in four textile started. IV antibiotics were given for possible
experienced depression and five workers were diagnosed pulmonary
establishments in the Philippines showed high concentration infection.
with AIDSThe patient
(Figure 1). later on showed improvement, and was
eventually weaned off from ventilatory support, extubated,
of cotton dust, high level of noise in the weaving areas, and
toxic chemicals in bleaching, dyeing, printing and finishing Mining Sector
processes.31 Also, women in the garment industry were TableMining
3. Cardiac Enzymes by ILO37 as one of the most unsafe
is considered
found to be exposed to extreme heat, dust from textile fibers, human activities.Reference
In the study
Range (mmoL)of the Result
Institute for
and ergonomic hazards.31 Occupational
Qualitative Health and Safety and Development
POSITIVE
In a study conducted in major leather tanneries in the (IOHSAD)
Troponin I in 1997, the reported leading types of accident in
Philippines, results showed that tanneries were unhygienic, theCK-MB
mines were being hit0-6.0 1.14
by falling objects, suffocation from
damp, with pungent odor, had poor housekeeping, and CK-TOTAL
chemical 21-232 injuries.38 Other 543
fumes, and crushing occupational
practiced improper disposal of chemicals. Workers were not health hazards in mining include exposure to intense heat,
given personal protective equipment even when handling poor ventilation, vibration, dust, fumes, repetitive stress
toxic chemicals such as sulfuric and formic acids, ammonia, injury (RSI), intense noise, manual handling (e.g., lifting) of
and chromium.32 The International Agency for Research on heavy machinery, and biological and chemical hazards. In
Figure
Cancer 1. andElectrocardiogram
the US Toxicologyupon admission
Program, categorizes underground mining, poor ventilation causes respiratory
chromium as a pulmonary carcinogen.32 failure that may lead to brain malfunction or even death in
In a pyrotechnic industry, child workers were noted to underground mining operations.38
transferred to the intensive care unit (ICU) for ventilatory
be exposed to explosion and fire risks, intestinal parasitism Cyanide, used by most Philippine gold mines, is known
support and closer monitoring. On bedside cardiac ultrasound,
and primary tuberculosis infection.33 to block the transfer of oxygen from the blood to the body
there was a finding of eccentric left ventricular hypertrophy,
tissues. Symptoms of poisoning due to cyanide include rapid
global hypokinesia with depressed overall systolic function
Services Industry breathing, gasping, tremors, convulsions, headaches,
with concomitant spontaneous echo contrast on left ventricular
In call/contact centers in the Philippines, workers dizziness and thyroid enlargement and eventually death.39
(LV) cavity suggestive of rheologic stasis, the ejection fraction
usually work at night to coincide with the regular business In the recent study by Lu, 102 water samples from various
was 25%, with moderate mitral regurgitation, moderate
hours
aortic of their clients with
regurgitation in North America
aortic or Europe.
sclerosis, severe This type
tricuspid sources including water drinking, irrigation, and surface
of work scheduling causes sleep disorders,
regurgitation with mild pulmonary hypertension, pulmonary eating water (rivers and creeks) showed levels of mercury and
regurgitation, and minimal pericardial effusion or pericardial cyanide2.inChest
Figure water.
radiograph
40
on admission

VOL. 45
VOL. 43 NO.
N0. 432009
2011 ACTA MEDICA
ACTA MEDICA PHILIPPINA
PHILIPPINA 55
13
Occupational Health and Safety in the Philippines CASE REPORT

Heart Failure
Accidentsand Short Stature in a 43 year-old male 39.43

Musdcukloskeletal disorders 13.71

Katerina T. Leyritana1, Ma. Czarlota M. Acelajado-Valdenor1, Amado O. Tandoc III2 and Agnes D. Mejia1
Cardiovascular diseases 11.65
1
Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila
Infectious diseases 8.98
2
Department of Pathology, College of Medicine, University of the Philippines Manila
Inflammatory disorders 8.47

Lithiasis 6.24

New Grow th/ Cancer 6.14

Medico-legal cases 3.01

Presentation of the cancer

Endocrine case 2.64 require regular laxative use. There was also a report of two
This is a case of a 43-year-old male presenting
Psychiatric disorders
with
2.38
short more syncopal episodes. He was brought to another doctor
stature and heart failure. The patient was admitted at the in a private hospital where the assessment was still a “heart
medicine ward of the Philippine General Hospital 0 5 (PGH) 10 15problem”.
20 25The 30 patient35 was 40again45 prescribed unrecalled
for dyspnea. This paper will investigate several Comprehensive
Source: DOLE-Overseas issues: medications
Social andforagain
Services Package OFWs 36 was lost to follow-up. This time,

differentiating congenital from acquired hypothyroidism, however, symptoms were persistent. He later consulted at
Figurerelationship
the 1. Percentage between
Distribution of Common Causes
hypothyroidism andof Morbidity
the of OFWs
another local(2003)
hospital, where he was admitted and managed
cardiomyopathies, and the therapeutic options in patients as a case of anemia and bronchial asthma. He was discharged
withIn cardiomyopathy
a study conducted secondary to hypothyroidism.
in small-scale mines in Camarines slightly
workersimproved after four
in the informal days,
sector ofonly
the to have recurrent
Philippines heart
consisting
The patient had been born full term
Norte, children ages 17 years old and below experienced to a then 31-year- failure symptoms, prompting admission
of farmers, fisherfolk, construction workers, and at PGH.
old Gravida
cough, 4 Parashortness
wheezing, 3 (G4P3),ofthe 4th of Three
breath. 9 siblings,
children withhad an Upon admission
waste/garbage pickersthewerepatient was to
exposed in various
mild respiratory
hazards.
apparently unremarkable delivery at
pneumonitis and two with pulmonary tuberculosis. About home facilitated by distress, with stable vital signs and no
Similarly in Zimbabwe, workers in rural and urban note of fever. Pertinent
informal
a traditional
65% of the total birth attendant.
number He was
of children had noted to beabove
lead levels normal 10 physical
sectors were exam findings
reportedincluded
to be short
exposedstature, thick lips,
to poor non-
working
at birth. The patient was allegedly
µg/dl with the highest value at 25 µg/dl. at 41par with age both pitting periorbital edema, dry skin, a displaced
conditions, lack of hygiene, and various ergonomic and apical impulse,
physically and mentally
In a small-scale mininguntilineight years
Western old whenworkers
Mindanao, he was crackles
chemicalon both lung
hazards. fields, and bilateral
Musculoskeletal non-pitting
and respiratory bipedal
disorders
said to have stopped growing in height.
were found to be exposed to high levels of mercury. He was brought to edema. There was also a 3 cm
were found prevalent among these workers. x 3 cm reducible
45 umbilical
a private doctor,complaints
Gastrointestinal whose diagnosis was undisclosed,
of the workers and he
were significantly hernia.TheHowever,
study also there was nothat
showed pallor, no neck veinpickers
waste/garbage distention,are
was given medications to increase height,
associated with elevated hair methylmercury levels. which the patient no apparent congenital malformations,
exposed to unsanitary work environments. Dorevitch no cardiac murmurs and
took for onlythe
Moreover, one study
month with
showed no improvement.
a relationship Throughbetween the and
Marder no clubbing.
noted thatThere solid was
wastealso no note
workers areofhighly
an anterior
exposed neck
to
years, the patient was apparently well,
elevated diastolic blood pressure and gastrointestinalalthough still of short mass.
a variety of toxic materials and bioaerosols. The authors 46

stature, with
complaint. 42 thick lips, coarse facial features and dry skin. alsoLaboratory
noted thatworkup showedpickers
waste/garbage cardiomegaly with risk
had higher pulmonary
of fatal
He was notably slow in ambulation.
In 1997, a study conducted in Itogon-Suyoc MineHe was said to have congestion, thoracic dextroscoliosis, and atheromatous
occupational injuries than the general workforce. Non-fatal aorta by
bronchial asthma
Incorporated at agevarious
showed 15 years, and sinceof
symptoms then he had been
occupationally chest
injuries radiograph,
in this groupand left ventricular
included hypertrophy by
musculoskeletal 12-lead
disorders,
taking salbutamol tablets occasionally for
related health risks among mine workers such as cough and bouts of dyspnea electrocardiogram (12-L ECG) (Figures 1 and
fractures, ocular trauma, bites and skin and gastrointestinal 2), normocytic
occurring one
breathing to twobeing
difficulty times abnormally
annually. high among exposed normochromic
diseases. Theseanemia groups(Hgb 90 mg/dL),
of workers are dyslipidemia,
also exposedand to
The patient’s symptoms started
workers. Other prevalent health symptoms among the in 2001 when he was pre-renal azotemia (serum creatinine
ergonomic hazards such as repetitive heavy 123 mmoL). Electrolytes
physical
reported workers
exposed to have weresudden loss of sweating,
excessive consciousness. During and
hypertension this on admission
activities showed
(e.g., lifting, slight hyponatremia,
carrying, hypokalemia,
pulling, and pushing). 47
time, the patient did not
constant muskuloskeletal pain.39 have any symptoms of heart failure; and hypochloremia (serum Na 136, K 3.35,
In the study of Yang et al.48 among Taiwanese Cl 86). Blood waste
gases
no prior seizures, cyanotic episodes, chest pain,
In the Cordilleras, a heavy equipment operator in Philex headache, or revealed partially compensated metabolic alkalosis
collectors, health problems associated with the job included with mild
blurring of vision. He regained consciousness
was suffocated when the ore gave in on the huge load-haul- shortly after and hypoxemia. The patient was noted
respiratory symptoms such as cough, wheezing and to be hypothyroid based
was brought
and-dump to a private
machine he was physician,
operating.whose assessment
43 Another worker was
was a on elevated serum
conditions such thyroid-stimulating
as chronic bronchitis, hormone as (TSH)
well and as
“heart problem”. He was prescribed unrecalled medications markedly decreased serum free thyroxine (FT4). The exact
crushed to the wall by large equipment. In 2003, many musculoskeletal symptoms and injuries. In Florida,
taken for a few months and eventually discontinued when values are shown in Tables 1 and 2.
miners suffered from hearing defects due to blasting municipal solid waste collectors were reported to experience
the syncopal episode did not recur. Upon admission to the wards, the patient was managed
operations in underground tunnels.44 In addition, the musculoskeletal disorders and dermal injuries. They also
In the next four years, the patient would develop as having congestive heart failure from cardiomyopathy
underground mine workers were exposed to extreme heat, experienced other injuries such as strains and sprains,
intermittent, progressive exertional dyspnea and bipedal secondary to acquired hypothyroidism. Oral loop diuretics,
loud noise, vibration of equipment, dust and fumes, among contusions, fractures, and lacerations.1
edema. Later on this would be accompanied by generalized angiotensin-converting enzyme (ACE) inhibitors, beta-
others because of the use of cyanide and mercury, and heavy In the Philippines, child labor is prevalent. Graitcer et
body weakness, anorexia, and constipation, severe enough to blockers, statins, and levothyroxine were started. Electrolyte
equipment and tractors that emit fumes underground.44 al.49 noted that occupational injury and mortality in children
correction was instituted. The sections of Endocrinology
exceed those of adult workers worldwide. Also, about six
and Cardiovascular Diseases were co-managing the patient
Discussion
Corresponding author: Ma. Czarlota Acelajado-Valdenor, M.D. million ccupational injuries occur among child laborers that
Department of Medicine together with the General Medicine service.
The study shows the prevalence of occupational translate into 2.5 million disabilities and 32,000 fatalities each
Philippine General Hospital He soon developed respiratory failure, upon which the
hazards and occupational diseases in the Philippines. This is year. In India, child labor is also prevalent. In a study in
Taft Avenue, Manila, 1000 Philippines considerations were acute pulmonary congestion, nosocomial
aTelephone:
major concern among workers. The study showed that
+632 554-8488 India among child workers in foot-wear manufacture,
pneumonia, to rule out an acute coronary event. He was later
Email: czarlota@yahoo.com

12 ACTA MEDICA
56 ACTA MEDICA PHILIPPINA
PHILIPPINA VOL.45
VOL. 43NO.
N0. 43 2009
2011
 Heart Failure
Occupational and Short
Health andStature
Safetyinina the
43 year-old male
Philippines

Table 1. Initial
children were Laboratory
exposed to Results
various physical hazards such as Cement plants are also hazardous. A study conducted
poor illumination, noise, poor ventilation, and chemical in nine cement plants in the Philippines showed that
CBC Blood chem. Urinalysis ABG
hazards such as leather dust, benzene found in glues and workers in these industries were exposed to hazards such as
other chemicalsReference Result
used as adhesives. Consequently, Reference
these Result
heat, noise and dust. Color
Okoye and straw
Umeh54 pH found eye7.408injuries
Value Value
children
WBC suffered
5-10
from respiratory
4.5
diseases,
RBS skin infections,
3.9-6.1 being
6.3 abnormally Transp high among
Clear industrial
pCO2 workers
49.1 in
nasal
RBC cancer, and
4-6 even neurotoxicity.
50
HGBA1C 4.27-6.07 Southern
6.4 Nigeria working in1.010
Sp Gravity cement factories,
pO2 coal 70
mines,
HGB 120-150 90 BUN 2.6-6.4 saw5.0mills, and iron pHand steelworks. 8.0 Eye HCO3
injuries were 31.3
noted
HCT Issues0.38-0.48
Gender 0.27 CREA 53-115 123caused by exposure
to be Sugar NEG dust,O2metal
to cement sat chips, 93.6
wood
MCV 80-100 FL ALB 34-50 32 Protein NEG FiO2 21%
The participation of women in the labor force is another fragments, coal stones, and welder’s arc rays. The study by
MCH 27-31 PG TAG 0.34-1.7 0.82 RBC 0-1 Temp 36.9
issue
MCHC of unprotected
320-360 G/L workers. Edralin14HDL and Estrella-Gust 15
0.91-1.56 Aydin
0.67 et al. found
55
WBC that cement 0-2 workers were exposed to
both
RDWstudied 11.5-15.5%
the feminization of the workforce,LDL specifically
1.1-3.8 oxidative
4.21 stress. CastThe study of Neghab and PBS Choobineh56
inPLT
the garment 200-400 Inc microchip,
industry, in shoe, TOTALandCHOLcomputer
4.2-5.2 5.25 Iranian Epith
among cementcell workers RareshowedSlightthatpoikilocytosis,
symptoms like
RETIC
manufacture 0.005-0.015
and the electronics industry, ASToperating inside
15-37 95 wheezing
cough, Bacteria
and shortness Occ’lof breath were significantly
acanthocytes, ovalocytes,
SEG 50-70% 48 ALT 30-65 91 Mucus th Rare slight toxic granulation,
export processing zones in the Philippines. The reported associated with exposure to cement dust. Chest
LYMPH 20-44% 50 Alk po4 184 Crystals Rare slight anisocytosis
occupational
MONO risks to women 2were low salaries,
2-9% NA exposure to
140-148 abnormalities
136.9 were
Am uratesalso found among cement workers due
toxic
EO substances,0-4% respiratory 0 diseases, and
K musculoskeletal
3.6-5.2 to exposure
3.35 to cement dust.56
BASO
problems. 3 0-2% 0 CL 100-108 86In a study conducted in major leather tanneries in the
BLAST 0% CA++ 2.12-2.52 2.37
Both women and men 0informal workers experience Philippines, results showed that tanneries were unhygienic,
P 2.27
occupational hazards but women are MG++ more vulnerable to
0.74-1 damp,
0.83 with pungent odor, poor housekeeping, and
occupational hazards. Women migrant workers are more improper disposal of chemicals. This is further confirmed by
typically subjected to sexual and physical abuses and the study by Stern,57 wherein workers involved in tanning
maltreatment from their employers.16 Women informal and finishing were found to be highly exposed to various
workers typicallyFunction
face a dual fat pad. Cardiac enzymes were not consistent with an acute
Table 2. Thyroid Testshazard, having both informal carcinogens. A study conducted among tannery workers in
and household work, and are thus doubly vulnerable to coronary event (Table 3), however,
Istanbul showed that workers commonly complained intravenous (IV) heparinof
Reference Value Result (overlapping with oral warfarin) was still
occupational
Free T4 illnesses. (0.8-2.0)
They are exposed to0.02 stress
ng/dLbrought gastrointestinal symptoms, bronchitis, andgivenasthma.to cover
Casesforof
about the presenceobstruction
of a possible LV thrombus
40% of as thedemonstrated
TSH by the physical environment,
(0.4-6.0) tedious24.75
fineUiu/ml
work, fast- respiratory of about respondents
paced production, aggravated by the burden of their by rheologic stasis
were detected using spirometry. on cardiac 58 ultrasound. Medications
reproductive biology.14 Women workers in the electronics wereInshifted to IV diuretics and inotropes;
the pyrotechnics industry in the Philippines, workers oral digoxin was
and garment industries were also subjected to extended and started. IV antibiotics were given for possible
were exposed to possible explosion and fire risks, intestinal pulmonary
intensified work manifested in both work intensification and infection.
parasitismTheand patient later ontuberculosis
primary showed improvement, infection and was
among
eventually weaned off from ventilatory support, extubated,
work extensification, time pressure to achieve quotas, exposed children. In the study of Johnson and Johnson,59
33

nightshift work, and exposure to various occupational the most prevalent upper extremity musculoskeletal
hazards.51 Women informal workers mostly experience Table
disorders3. Cardiac Enzymes
in different occupational sectors were recorded
changes in blood pressure and heart rate, ulcers, migraines, among the workers, Reference Rangeby
followed matchstickResult
(mmoL) makers. Skin
and menstrual irregularities.3,9 lesions such
Qualitative as contact dermatitis of the hands were also
POSITIVE
Women workers remain a vulnerable segment of the found among
Troponin I workers involved in fireworks and matchstick
working population due to the nature of their work and the CK-MB
making. 0-6.0 1.14
associated hazards that they are exposed to. Recent statistics CK-TOTAL
Occupational hazards 21-232
were documented to543exist in call
in the Philippines revealed that female workers in 2010 centers in the Philippines, recently growing as an industry in
accounted for 15.0 million of the labor force in the country. the country. In the study by Halford and Cohen,60 call center
In the study of Fisher and Gunnison,52 women were found workers complained of musculoskeletal disorders. This is
more at risk of experiencing violence in the workplace than supported by the study of Sprigg et al.61 among call center
Figure
males in1. Electrocardiogram
all types of jobs. upon Women admission
who are employed in agents, where the authors found a correlation between job-
teaching institutions and law enforcement and retail and related strain and upper body and lower back
transportation are vulnerable to robbery and assault. In musculoskeletal disorders. In a study among call center
transferred to the intensive care unit (ICU) for ventilatory
agriculture, a study showed that Hispanic women workers in Taiwan, the most common health complaints
support and closer monitoring. On bedside cardiac ultrasound,
agricultural workers were at a higher risk than males in were eye strain, painful throat, and musculoskeletal
there was a finding of eccentric left ventricular hypertrophy,
sustaining sprains, strains and lacerations.53 symptoms.62
global hypokinesia with depressed overall systolic function
In another study, women workers were found more at Migrant workers are another significant sector in the
with concomitant spontaneous echo contrast on left ventricular
risk of developing occupational skin diseases than men in Philippines. Today, it is estimated that about 8 million
(LV) cavity suggestive of rheologic stasis, the ejection fraction
any occupational group. The incidence of hand eczema, in Filipinos are working abroad.12 From 1990 to 1994, the
was 25%, with moderate mitral regurgitation, moderate
particular,
aortic was foundwith
regurgitation higher
aorticin women
sclerosis,compared to men
severe tricuspid remittances of migrant Filipinos amounted to $4.8 billion. In
engaged in various jobs based on the study
regurgitation with mild pulmonary hypertension, pulmonaryof Diepgen and 2009 alone (latest data), the remittances of overseas Filipino
Kanerva. 46
regurgitation, and minimal pericardial effusion or pericardial workers2. to
Figure the radiograph
Chest Philippines on amounted
admission to P17.3 million. The

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Occupational Health and Safety in the Philippines CASE REPORT

Heart Failure
significance of this contribution to the Philippine andeconomy
Short isStature __________in a 43 year-old male
no small thing and the government recognizes it by hailing
References
migrantKaterina
workers T. Leyritana
as “new 1,economic Ma. Czarlota M. Acelajado-Valdenor
heroes”. However,
1.
1
, Amado O. Tandoc III2 and Agnes D. Mejia1
Bureau of Labor and Employment Statistics (BLES), Glossary of Terms.
protection for the migrant workforce has not been given by [Online]. 2011[cited 2010 June]. Available from
the government.1Department
They payofconsiderable
Medicine, College of Medicine
fees in order andtoPhilippine
be General Hospital, University of the Philippines Manila
http://www.bles.dole.gov.ph.
employed overseas, but of the
2
Department
8 million of Pathology,
FilipinosCollege
workingof Medicine,
2. University
BarcelonaofNS. the Work-Related
Philippines Manila
Injuries, Illnesses Claim Millions of Lives,
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needs. Despite being hailed “heroes” in their home country, 3. Estrella-Gust D. National Profile on Occupational Health and Safety
these Filipinos experience abuse and exploitation that range (Philippines) Implementing Rules and Regulations of Executive Order
307 Creating the Occupational Safety and Health Center in the
from contract violations, termination without cause, rape,
Employees’ Compensation Commission. [Online]. 2006 [cited 2010
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migrant/foreign workers Presentation of the case
were reported to have an increased require
4. regular Safety
Occupational laxative anduse.HealthThere was
Center, OSHalso a report [Online].
Regulations. of two
riskThis is a case of
of non-fatal a 43-year-old
and male presenting
fatal occupational injuries with short
compared more2010syncopal
[cited 2010 episodes. He was
June] Available brought to another doctor
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5. Haspels N, de los Angeles-Bautista F, Boonpala P, Bose C. Action
stature and Spanish
with native heart failure.
workers. The 63 patient was admitted at the in a private hospital where the assessment was still a “heart
against child labour: Strategies in education: Country experiences in the
medicine ward has
This study of theshown Philippine General Hospital
that occupational hazards(PGH)are a problem”.
mobilization Theof teachers,
patienteducators
was again and their prescribed
organizations unrecalled
in combating
for dyspnea.
major concern This of thepaper
labor will
force.investigate several concern
This is of greater issues: medications
child labour. and againGeneva;
ILO/IPEC, was 1999.
lost to follow-up. This time,
differentiating
when occupational congenital
hazards from lead toacquired
illnesses hypothyroidism,
and diseases. however,
6. National symptoms were(NSO),
Statistics Office persistent.
Labor ForceHe laterSurvey:consulted
Labor Force at
Statistics. In Bureau of Labor and Employment Statistics (BLES) 2011.
the relationship between hypothyroidism and the another local
[Online].
hospital,
2011
where
[cited
he2011
was admitted
July].
and
Available
managed from
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http://www.bles.dole.gov.ph.
withThe
cardiomyopathy
study attempted secondary
to present to hypothyroidism.
comprehensive data on slightly
7. improved
National Statisticalafter four days,
Coordination Boardonly to have
(NSCB), recurrent
Overseas heart
Employment
Statistics (OES) of the Philippine Overseas Employment Administration
The patient had been born full term
occupational safety and health in the Philippines considering to a then 31-year- failure symptoms, prompting admission at PGH.
(POEA): Number of Deployed Land Based Overseas Filipino Workers
old Gravida
that there is 4 Para 3 (G4P3),collection
insufficient the 4th of of 9 siblings,
OSH data with by an Upon
by Yearadmission
and Major World the Groupings.
patient was [Online].in 2009
mild[cited
respiratory
2010 July].
apparently unremarkable delivery
government agencies. This study considered various dataat home facilitated by distress,
Availablewith stable
from vital signs
http://www.nscb.gov.ph.and no note of fever. Pertinent
a traditional
sources birth attendant.
and statistical records He was noted
in order to show to the
be current
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8. Bureau exam findings
of Working included
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at birth. The patient was allegedly at
state of occupational safety and health in the Philippines. par with age both pitting periorbital edema, dry skin, a displaced apical impulse,
Available from bwc.dole.gov.ph/.
physically
The and mentally
study revealed until eight
that various years oldgroupings
occupational when he was and crackles
9. Bureau onofboth
Laborlung fields, andStatistics,
and Employment bilateral non-pitting
Labstat Updates 2010 bipedal
14 (5).
said to have stopped growing in height.
industry types are faced with hazards that endanger the He was brought to edema. There
[Online]. was
2003 also
and a
2007 3 cm
[cited x 3
2010 cm reducible
April]. umbilical
Available from
a private doctor, whose diagnosis
health, safety and well-being of their workers. was undisclosed, and he hernia. However,
www.bles.dole.gov.ph/. there was no pallor, no neck vein distention,
10. Department of Labor and Employment, United Nation Children's
was given
In manymedications
countries, to increase
there is height, which the
insufficient patient
statistical no apparent congenital malformations, no cardiac murmurs
Emergency Fund survey: Child Labor. [Online]. 2007 [cited 2010 July].
took for only one month with no improvement.
information on occupational diseases due to inaccurate Through the and no clubbing. There was also no note of an anterior neck
Available from http://ro6.dole.gov.ph/.
years, the patient was apparently
diagnosis or the lack of acknowledgement of work- well, although still of short mass.
11. Magna Carta for the Informal Sector Alliance, Policy Brief on
stature, withofthick Occupationalworkup
Laboratory Health and Safety cardiomegaly
showed [Online]. 2009 [cited with 2010 August].
pulmonary
relatedness theselips, coarseInfacial
illnesses. general,features and dry
the current skin.
state of Available from http://www.magnacarta.net/.
He was notably
occupational safetyslowand in ambulation.
health in the He Philippines
was said toneeds have congestion, thoracic dextroscoliosis, and atheromatous aorta by
12. National Statistical Coordination Board, Overseas Employment Statistics
bronchial asthma at age 15 years, and since
further improvement, especially in terms of data collection, then he had been chest radiograph,
(OES) of the Philippine and left ventricular
Overseas Employment hypertrophy
Administration by 12-lead
(POEA):
taking salbutamol tablets occasionally
coverage of industries and occupational sectors, and for bouts of dyspnea electrocardiogram
Number of Deployed (12-LLandECG)Based (Figures
Overseas 1Filipino
and 2), normocytic
Workers by Year
and Major World Groupings. [Online]. 2010 [cited 2010 July]. Available
occurring one to
dissemination to both two times annually.
public and private sectors. normochromic anemia (Hgb 90 mg/dL), dyslipidemia, and
from http://www.nscb.gov.ph.
The patient’s symptoms started
Establishments should more readily comply with in 2001 when he was pre-renal azotemia (serum creatinine 123 mmoL).
13. Lu J. Environmental and Occupational Hazard Exposures of Adult and Electrolytes
reported
regulations to on
have sudden losssafety
occupational of consciousness. During this
and health enforcement on admission
Child Laborers showed
in Metro slight
Manila, hyponatremia,
Manila Studies Program hypokalemia,
Situationer.
time, the patient did not have any symptoms
in the workplace. The sanctions for non-compliance should of heart failure; and hypochloremia
1999; 4 (4): 1-20. (serum Na 136, K 3.35, Cl 86). Blood gases
14. Edralin D. Assessing the Situation of Filipino Women Working in the
no prior seizures, cyanotic
be reviewed and strictly implemented. episodes, chest pain, headache, or revealed partially compensated metabolic alkalosis with mild
CALABARZON, Philippines. Philippine Journal of Labor and Industrial
blurring of vision. He regained consciousness
The limited number of labor inspectors in the shortly after and hypoxemia. The patient was noted
Relations.2001; 31 (1&2) Quezon City: U.P. SOLAIR. to be hypothyroid based
was brought (280
Philippines to a private
in all) physician,
makes it whose virtually assessment
impossible wastoa on
15. elevated
Estrella-Gust serum thyroid-stimulating
D. National Profile on Occupational hormone Health(TSH) and
and Safety
“heart problem”. He was prescribed unrecalled medications markedly decreased
(Philippines). serum
[Online]. 2006free thyroxine
[cited 2010 July]. (FT4). The exact
Available from
monitor the compliance of over 800,000 companies all over www.ilosafetyconference2009.org.
taken for a few months and eventually discontinued when values are shown in Tables 1 and 2.
the country. This is not considering the small enterprises, 16. Migrante International, International Alliance of Filipino Migrant
the syncopal episode did not recur. Upon admission
Organizations. to the2010
[Online]. wards, [citedthe 2010patient
July]. was managed
Available from
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In the next four years, the patient would develop as having congestive heart failure from cardiomyopathy
http://migrante.tripod.com.
are not given priority. The record keeping by government 17. Lu J. Organizational work factors among workers and supervisors in
intermittent, progressive exertional dyspnea and bipedal secondary to acquired hypothyroidism. Oral loop diuretics,
agencies is also insufficient. export processing zones which support global markets. Ind Health.
edema. Later on this would be accompanied by generalized angiotensin-converting
2008; 46(5): 435-42. enzyme (ACE) inhibitors, beta-
Occupational safety and health provisions are necessary
body weakness, anorexia, and constipation, severe enough to blockers,
18. Lu J. statins,
Electronics andBlood
levothyroxine
Lead Analysis were of started.
Workers Electrolyte
in Electronic
tools in achieving economic productivity through
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productive and healthy workers. 19. Employees Compensation Commission, Cases of Occupational Diseases
and Cardiovascular Diseases were co-managing the patient
Corresponding author: Ma. Czarlota Acelajado-Valdenor, M.D. (1989-1993.) [Online]. 1989-1993 [cited 2010 July]. Available from
Department of Medicine together with the General Medicine service.
www.ncc.gov.ph.
_________________
Philippine General Hospital
Acknowledgment 20. He
Socialsoon developed
Security System, respiratory failure, Diseases
Cases of Occupational upon which the
(1989-1993).
Taft Avenue, Manila, 1000 Philippines
Acknowledgment is cited for Ms. Diana Estolero, my research considerations
[Online]. 1989-1993were acute
[cited pulmonary
2010 July]. Availablecongestion, nosocomial
from www.sss.gov.ph.
Telephone: +632 554-8488 21. Occupational Safety and Health Center (OSHC), Survey on the Health
assistant, for assistance given to this manuscript. pneumonia, to rule out an acute coronary event. He was later
Effects of Organophosphate exposure among Framers in the Cordillera
Email: czarlota@yahoo.com

12 ACTA MEDICA
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VOL. 43NO.
N0. 43 2009
2011
 Heart Failure
Occupational and Short
Health andStature
Safetyinina the
43 year-old male
Philippines

TableAdministrative
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24.RBCCheng C. Pesticides
4-6 and its hazardous effects HGBA1C 4.27-6.07
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HGB 120-150
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Safety and Health CREA Assessment 53-115
0.27Center (OSHC), of the 123 Sugar NEG
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MCV Health Status80-100 FL
of Deep-Sea Fishermen Practicing ALBthe "Pa-aling" Method
34-50 45. 32Loewenson RH. Protein
Health impact NEG of occupational FiO2risks in the21%informal
MCH in Palawan. 27-31 PG
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MCHC 320-360 G/L
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VOL. 43 NO.
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2011 ACTA MEDICA
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